Question 1

A client at 20 weeks' gestation asks the midwife if she will be able to breastfeed her baby after birth. The client has a history of type 2 diabetes, which has been well - controlled before and during the pregnancy. The client has a BMI of 34. Which of the following statements by the midwife is the most appropriate?

Accepted Answer

The midwife should inform the client that mothers with type 2 diabetes are encouraged to breastfeed their babies after birth and that she may need less insulin while breastfeeding. Within hours after birth, the client's need for insulin may abruptly drop. It is believed that the lowering effect of breastfeeding is caused by the process of milk production. Serum glucose is the main substance used in producing the breast milk and energy is much needed for milk production. The client may have to adjust her caloric levels, physical activity and insulin needs after birth to ensure the well - beings of both the mother and child during breastfeeding. Insulin does not cross into the breast milk.

Question 2

A midwife is creating a teaching plan for a G1P0 client at 12 weeks' gestation. The midwife focuses on breast care once colostrum secretion begins. Which of the following teachings is not included in the teaching plan?

Accepted Answer

The client should wash her breasts with clear tap water daily, without soap, to remove the colostrum and minimize the risk of infection. A firm supportive bra with wide straps is recommended because it can spread the weight across the shoulders. If colostrum secretion becomes excessive, the client may place gauze squares inside the bra and change them frequently to keep the breasts dry.

Question 3

A midwife is creating a care plan for a client who is in early labor. Which of the following guidelines is least important?

Accepted Answer

The midwife should avoid projecting a definite time limit for labor to be completed. The length of labor can vary from client to client and still be within the normal limits. The outcomes should be realistic. Labors usually occur over a short period of time, and the midwife should ensure that the outcomes are met within this time period. The female client and her support person should be incorporated so that the labor experience is a shared one. Comfort promotion is essential.

Question 4

A client is admitted to the labor and delivery unit. A midwife is assessing the fetal heart tone monitor tracing and notes late decelerations. Which of the following is the most effective intervention?

Accepted Answer

The most effective action for the midwife to take is to administer oxygen through a face mask. The client is most likely experiencing uteroplacental insufficiency, which usually results from decreased flow of oxygenated blood to the fetus during contractions. The client should be placed in the left side lying position to improve fetal circulation and oxygenation. Oxytocin increases uteroplacental insufficiency and should not be administered; it can aggravate or worsen fetal hypoxemia.

Question 5

A midwife induces labor through amniotomy. The amniotic fluid is assessed and the midwife notes that the amniotic fluid is red in color. This finding most likely suggests:

Accepted Answer

Red amniotic fluid most likely suggests fetal trauma. The characteristics of the amniotic fluid, such as color, odor and quantity of fluid, should be noted after amniotomy. A foul odor suggests infection. Excessive or too little amniotic fluid suggests fetal congenital disorder. Fetal distress may be manifested with green - colored amniotic fluid.

Question 6

A midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The midwife notes decelerations at unpredictable times in relation to contractions. The midwife suspects which of the following conditions?

Accepted Answer

The midwife suspects cord compression. Variable deceleration is manifested by decelerations occurring at unpredictable times in relation to contractions. This type of variability usually occurs after rupture of the membranes or in cases of oligohydramnios. Cephalopelvic disproportion is manifested by early decelerations before the head is fully descended. Early decelerations normally occur during the final stages of labor. Uteroplacental insufficiency is manifested by late decelerations.

Question 7

A midwife is caring for a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

Accepted Answer

The most effective intervention during the first stage of labor is to instruct the client to void at least every two hours. Bladder fullness may be misinterpreted as sensations of labor by the client. The midwife must learn not to interrupt the client during contraction time. If the amniotic membranes have not ruptured, the client must be encouraged to ambulate. Therapeutic touch is recommended.

Question 8

A midwife is about to perform an amniotomy on a client who is in the active phase of labor. Before performing the procedure, the midwife informs the client that after the amniotomy, she can expect:

Accepted Answer

The midwife should inform the client that after amniotomy, she can expect increased efficiency of uterine contractions. Amniotomy is an artificial method of rupturing the membrane to induce labor. Rupturing of the membranes allows direct contact of the fetal head with the cervix, increasing the efficiency of the contractions. Fluttery feeling in the chest is expected after the administration of tertbutaline.

Question 9

A midwife is managing the care of a G3P2 client. The birthing room is converted into a birth room when the cervix is dilated to:

Accepted Answer

The birthing room is converted into a birth room when the client's cervix is dilated to 7 to 9 cm. The second stage of labor is usually shorter for multipara clients. For primipara clients, this action may be delayed until the head of the fetus has crowned to the size of a quarter, or when the cervix is fully dilated and descent has occurred.

Question 10

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The midwife reminds the staff midwife to position the client in which of the following positions in the operating room?

Accepted Answer

The midwife reminds the staff nur midwife se to position the client in supine position, with a wedge placed under the right hip, in the operating room. The enlarging uterus compresses the vena cava and the descending aorta of the client, which impedes blood flow to the lower extremities and uterus. The side - lying position is the most ideal position during pregnancy, as it displaces the uterus off the compressed structures. In an abdominal surgery, the client should be positioned in supine position. To displace the uterus and to prevent decreased blood flow to the uterus, a wedge should be placed under the right hip.

Question 11

A midwife is managing the care of a G1P0 client who is about to be placed in the lithotomy position. A registered midwife is positioning the client correctly and safely if which of the following nursing actions is observed by the midwife?

Accepted Answer

The registered midwife is correctly and safely positioning the client in lithotomy position only when the midwife is scrubbing. Lying longer for more than an hour in the lithotomy position may cause pelvic congestion and hemorrhage, so it is important that the client is placed in this position only when the procedure is about start. To prevent constriction, the strap holding the leg should not be secured too tightly . Once the client is in lithotomy, the top portion of the table is raised to 30 to 60 degrees for more effective pushing. The legs must be raised at the same time to prevent straining the client's back and abdominals.

Question 12

A client comes to the facility and tells the midwife that she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

Accepted Answer

Contractions that are initially felt in the lower back and then sweep around to the abdomen in a wave are a sign of true labor. Other signs of true labor include irregular contractions becoming regular, continuous contractions independent of activity level, increase in the duration, frequency and intensity of the contractions and occurrence of cervical dilatation. The other options are signs of false labor.

Question 13

After the placental delivery, which of the following is the next action of the midwife?

Accepted Answer

After the placental delivery, the next action of the midwife is to inspect the placenta. Before administering oxytocics, the midwife should ensure that the placenta is intact and without abnormalities. Inspection allows the midwife to determine if any of the cotyledons are left inside the uterus. The baseline blood pressure is obtained before administering oxytocin, since oxytocin may cause hypertension.

Question 14

Which of the following clients is most likely considered for vacuum extraction?

Accepted Answer

The most appropriate client for vacuum extraction is the 43 - year - old client in prolonged second stage of labor with a fetal position of LOA.

Question 15

A client gives birth to a baby girl through vaginal birth. After placental delivery, which of the following assessment findings indicates that further evaluation of the client is necessary?

Accepted Answer

A fundus located at the level of the umbilicus after the delivery of the placenta indicates that further evaluation of the client is necessary. After placental delivery, the uterine fundus is usually firm, and the fundus is usually located about two fingerbreadths below the umbilicus. In vaginal births, about 300 to 500 mL of blood is lost. The specific gravity increases due to decreased fluid intake during labor.

Question 16

A client has just given vaginal birth to an eight - pound baby boy. A few minutes after the delivery, the midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The midwife interprets these observations as:

Accepted Answer

The midwife interprets these as signs of placental separation. Placenta separation occurs minutes after birth as the uterus resumes contractions. The signs of placental separation include lengthening of the umbilical cord, a gush of vaginal blood and change in the shape of the uterus.

Question 17

A midwife notes that the separation of placenta from the uterus via the Schultze mechanism. This means that:

Accepted Answer

The Schultze mechanism indicates that the placenta's center portion separated first from the uterus and that the fetal surface emerges first from the vagina. The fetal surface is smooth and shiny, whereas the maternal surface appears dull red and feels rough. The placenta separates from the uterus via one of two mechanisms: the Schultze mechanism and the Duncan mechanism. The Duncan mechanism indicates that the margin of the placenta separated first from the lining of the uterus and that the maternal surface emerges from the vagina first.

Question 18

Which of the following factors contribute(s) to a successful labor?
I. The client's pelvis is of adequate size and contour.
II. The fetus is in an advantageous position and presentation and is of appropriate size.
III. The uterine contractions are adequate.
IV. The client has a strong sense of self - esteem.

Accepted Answer

A successful labor depends on the 4 Ps: the passage, the passenger, the power of labor and the client's psyche. The passage is the route the fetus has to travel from the uterus, through the cervix and vagina and into the external perineum. The passenger is the fetus. Power refers to adequate uterine contractions without which full dilatation may not be possible. Clients who have a strong sense of self - esteem manage labor the best.

Question 19

A G3P2 client at 38 weeks' gestation has been in the second stage of labor for more than 3 hours. An epidural anesthesia has not been administered. A vacuum extraction is being considered. Which of the following assessment findings would signal that the extraction can be attempted?

Accepted Answer

Before vacuum extraction is attempted, the midwife should ensure that the client's amniotic membranes have already ruptured. Other requirements include full dilatation of the cervix and the fetal head at the level of the ischial spines. There should be no suspicion of cephalopelvic disproportion. The bladder must be emptied by catherization or spontaneous voiding. A multiparous client without an epidural anesthesia is expected to complete the second stage of labor within one to two hours.

Question 20

A midwife is reviewing the laboratory tests of a client who is in labor. The laboratory findings include a hemoglobin level of 10 g/dL and a hematocrit concentration of 34%. The midwife is correct if she determines that the client is at risk for which of the following during the postpartum period?

Accepted Answer

The client is at risk for postpartum infection. Research reveals that clients in labor who have anemia, which is demonstrated by low hemoglobin and hematocrit levels, have increased risk for postpartum infection, cardiac decompensation and poor wound healing. Decreased hemoglobin or hematocrit does not increase a client's risk of hemorrhage.

Quiz 2: Labor Birthand Immediate Postpartum